Postpartum Depression and Role of Serum Trace Elements
Abstract
Postpartum depression (PPD) is a major depressive disorder that most often emerges within 6 to 12 weeks of delivery, but can happen any time up to 1 year after birth. In developed countries, the incidence of postnatal depression is about 10-15% in adult women depending upon the diagnostic criteria, timing of screening and screening instruments used. Mothers with depressive symptoms have been found to have more complex behavioral contacts with their children; this situation can damage family relationships, and even leads to infanticide. Various pathophysiologies are proposed for postpartum depression: Nutritional deficiencies, iron deficiency anemia, rapid decrease in the levels of reproductive hormones following delivery, alterations in hypothalamic-pituitary-adernocortical mechanism and alterations in neurotransmitter levels. Among pathophysiologies of postpartum depression, the role of trace elements is highlighted. The purpose of this review is to assess the role of trace elements including zinc, magnesium, iron and copper in PPD. Zinc as a trace element has the second highest concentration of all transition metals in the brain, and its deficiency is associated with behavioral disturbances. Lower zinc blood concentration was found in women with postpartum depression. Another trace element, magnesium, also influences the nervous system via its actions on the release and metabolism of neurotransmitters. Various studies have focused on antidepressant-like effects of magnesium and its deficiency has been reported in depression. Depletion of magnesium stores during pregnancy is hypothesized to be the cause of postpartum depression. Iron deficiency is the most common single nutrient deficiency in the world. There is an association between anemia and depressive disorders. Copper has been recognized as an essential element for many years. Iron also plays a vital role in neurological disorders and its levels are relevant to postpartum depression. Involvement of trace elements can be seen in pathophysiologies of PPD in different ways. Therefore, trace element supplementation can be an alternative treatment for patients with PPD.
Ghasemi M, Montaser-Kouhsari L, Shafaroodi H, Nezami BG, Ebrahimi F, Dehpour AR. NMDA receptor/nitrergic system blockage augments antidepressant-like effects of paroxetine in the mouse forced swimming test. Psychopharmacology 2009;206:325-333.
WHO. World Health Organization Web site . [ Home page ] 23 June 2008. [cited; Available from: http://www.who.int/mental_health/manage ment/depression/definition/en/
Josefsson A, Angelsi L, Berg G, Ekstrmِ CM, Gunnervik C, Nordin C, et al. Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms. Obstet Gynecol 2002;99:223- 228.
Bodnar LM, Wisner KL. Nutrition and depression: implications for improving mental health among childbearing-aged women. Biol Psychiatry 2005;58:679-685.
Green AD, Barr AM, Galea LAM. Role of estradiol withdrawal in ‘anhedonic’sucrose consumption: A model of postpartum depression. Physiol Behav 2009;97:259- 265.
Spinelli MG. Neuroendocrine effects on mood. Rev Endocr Metab Disord 2005;6:109-115.
Rapkin AJ, Mikacich JA, Moatakef-Imani B, Rasgon N. The clinical nature and formal diagnosis of premenstrual, postpartum, and perimenopausal affective disorders. Curr Psychiatry Rep 2002;4:419-428.
Doucet S, Dennis CL, Letourneau N, Blackmore ER. Differentiation and Clinical Implications of Postpartum Depression and Postpartum Psychosis. J Obstet Gynecol Neonatal Nurs 2009;38:269-279.
Steiner M, Dunn E, Born L. Hormones and mood: from menarche to menopause and beyond. J Affect Disord 2003;74:67-83.
Klainin P, Arthur DG. Postpartum depression in Asian cultures: A literature review. Int J Nurs Stud 2009;46:1355- 1373.
Marcus SM. Depression during Pregnancy: Rates, Risks and Consequences. Can J Clin Pharmacol 2009;16:15-22.
Leung BMY, Kaplan BJ. Perinatal Depression: Prevalence, Risks, and the Nutrition Link—A Review of the Literature. J Am Diet Assoc 2009;109:1566-1575.
Spinelli MG. Maternal infanticide associated with mental illness: prevention and the promise of saved lives. Am J Psychiatry 2004;161:1548-1557.
Bloch M, Rotenberg N, Koren D, Klein E. Risk factors for early postpartum depressive symptoms. Gen Hosp Psychiatry 2006;28:3-8.
Roux G, Anderson C, Roan C. Postpartum depression, marital dysfunction, and infant outcome: a longitudinal study. J Perinat Educ 2002;11:25-36.
Beckley EH, Finn DA. Inhibition of progesterone metabolism mimics the effect of progesterone withdrawal on forced swim test immobility. Pharmacol biochem behav 2007;87:412-419.
Bloch M, Rotenberg N, Koren D, Klein E. Risk factors associated with the development of postpartum mood disorders. J Affect Disord 2005;88:9-18.
Clay CPT, Seehusen MAJ. A review of postpartum depression for the primary care physician. South Med J 2004;97:157- 161.
Panthangi V, West P, Savoy-Moore RT, Geeta M, Reickert E. Is Seasonal Variation Another Risk Factor for Postpartum Depression? J Am Board Fam Med 2009;22:492-497.
Beck CT. Revision of the postpartum depression predictors inventory. J Obstet Gynecol Neonatal Nurs 2002;31:394-402.
Bodnar LM, Cogswell ME, McDonald T. Have we forgotten the significance of postpartum iron deficiency? Am J Obstet Gynecol 2005;193:36-44.
Maguire J, Mody I. GABAAR plasticity during pregnancy: relevance to postpartum depression. Neuron 2008;59:207-213.
Zonana J, Gorman JM. The Neurobiology of Postpartum Depression. CNS Spectr 2005;10:792-799.
Bäckström T, Andersson A, Andree L, Birzniece V, Bixo M, Björn I, et al. Pathogenesis in menstrual cycle-linked CNS disorders. Ann N Y Acad Sci 2003;1007:42-53.
Flores DL, Hendrick VC. Etiology and treatment of postpartum depression. Curr Psychiatry Rep 2002;4:461-466.
Skalkidou A, Sylvén SM, Papadopoulos FC, Olovsson M, Larsson A, Sundstr m- Poromaa I. Risk of postpartum depression in association with serum leptin and interleukin-6 levels at delivery: A nested case–control study within the UPPSAT cohort. Psychoneuroendocrinology 2009;34:1329-1337.
Szewczyk B, Poleszak E, Wla P, Wr bel A, Blicharska E, Cichy A, et al. The involvement of serotonergic system in the antidepressant effect of zinc in the forced swim test. Prog Neuropsychopharmacol Biol Psychiatry 2009;33:323-329.
Groer MW, Morgan K. Immune, health and endocrine characteristics of depressed postpartum mothers. Psychoneuroendocrinology 2007;32:133- 139.
Rosa AO, Lin J, Calixto JB, Santos ARS, Rodrigues ALS. Involvement of NMDA receptors and L-arginine-nitric oxide pathway in the antidepressant-like effects of zinc in mice. Behav Brain Res 2003;144:87-93.
Cardoso CC, Lobato KR, Binfaré RW, Ferreira PK, Rosa AO, Santos ARS, et al. Evidence for the involvement of the monoaminergic system in the antidepressant-like effect of magnesium. Prog Neuropsychopharmacol Biol Psychiatry 2009;33:235-242.
Eby GA, Eby KL. Rapid recovery from major depression using magnesium treatment. Med Hypotheses 2006;67:362- 370.
Pearlstein T. Perinatal depression: treatment options and dilemmas. J Psychiatry Neurosci 2008;33:301-318.
Bhatia SC, Bhatia SK. Depression in women: diagnostic and treatment considerations. Am Fam Physician 1999;60:225-234.
Dennis CL, Chung-Lee L. Postpartum depression help-seeking barriers and maternal treatment preferences: a qualitative systematic review. Birth 2006;33:323-331.
Nowak G, Szewczyk B, Pilc A. Zinc and depression. An update. Pharmacol Rep 2005;57:713-718.
Frederickson CJ, Koh JY, Bush AI. The neurobiology of zinc in health and disease. Nat Rev Neurosci 2005;6:449- 462.
Goldhaber SB. Trace element risk assessment: essentiality vs. toxicity. Regul Toxicol Pharmacol 2003;38:232- 242.
Haghollahi F, Ramezanzadeh F, Norouzi M, Shariat M, Mahdavi A, Foroshani AR, et al. Zinc Deficiency in First Year Female Students of Tehran University of Medical Sciences. Journal of Family Reproductive Health 2008;2:81-86.
Dreosti I. Zinc and the gene. Mutat Res 2001;475:161-167.
Smart TG, Hosie AM, Miller PS. Zn2+ ions: modulators of excitatory and inhibitory synaptic activity. Neuroscientist 2004;10: 432-442.
Cunha MP, Machado DG, Bettio LEB, Capra JC, Rodrigues ALS. Interaction of zinc with antidepressants in the tail suspension test. Prog Neuropsychopharmacol Biol Psychiatry 2008;32:1913-1920.
Takeda A. Movement of zinc and its functional significance in the brain. Brain Res Rev 2000;34:137-148.
Farzin L, Moassesi ME, Sajadi F, Amiri M, Shams H. Serum Levels of Antioxidants (Zn, Cu, Se) in Healthy Volunteers Living in Tehran. Biol Trace Elem Res 2009;129:36-45.
Kroczka B, Branski P, Palucha A, Pilc A, Nowak G. Antidepressant-like properties of zinc in rodent forced swim test. Brain Res Bull 2001;55:297-300.
Mustak MS, Rao TSS, Shanmugavelu P, Sundar NMS, Menon RB, Rao RV, et al. Assessment of serum macro and trace element homeostasis and the complexity of inter-element relations in bipolar mood disorders. Clin Chim Acta 2008;394:47- 53.
Wójcik J, Dudek D, Schlegel-Zawadzka M, Grabowska M, Marcinek A, Florek E, et al. Antepartum/postpartum depressive symptoms and serum zinc and magnesium levels. Pharmacol Rep 2006;58:571-576.
Szewczyk B, Sowa M, Czupryn A, Wiero ska JM, Bra ski P, Sadlik K, et al. Increase in synaptic hippocampal zinc concentration following chronic but not acute zinc treatment in rats. Brain Res 2006;1090:69-75.
Loyke HF. Effects of elements in human blood pressure control. Biol Trace Elem Res 2002;85:193-209.
Heiden A, Frey R, Presslich O, Blasbichler T, Smetana R, Kasper S. Treatment of severe mania with intravenous magnesium sulphate as a supplementary therapy. Psychiatry Res 1999;89:239-246.
Imada Y, Yoshioka S, Ueda T, Katayama S, Kuno Y, Kawahara R. Relationships between serum magnesium levels and clinical background factors in patients with mood disorders. Psychiatry Clin Neurosci 2002;56:509-514.
Wacker WE, Parisi AF. Magnesium metabolism. N Engl J Med 1968;278:712.
Nahar Z, Azad MAK, Rahman MA, Rahman MA, Bari W, Islam SN, et al. Comparative Analysis of Serum Manganese, Zinc, Calcium, Copper and Magnesium Level in Panic Disorder Patients. Biol Trace Elem Res 2009;133:1-7.
Fujimori K, Ishida T, Yamada J, Sato A. The Effect of Magnesium Sulfate on the Behavioral Activities of Fetal Goats. Obstet Gynecol 2004;103:137-142.
Durlach DBP. Mechanisms of Action on the Nervous System in Magnesium Deficiency and Dementia. In: Yasui M, eds. Mineral and metal neurotoxicology. New York, CRC Press; 1997.
Singewald N, Sinner C, Hetzenauer A, Sartori SB, Murck H. Magnesium-deficient diet alters depression-and anxiety-related behavior in mice—influence of desipramine and Hypericum perforatum extract. Neuropharmacology 2004;47:1189-1197.
Jellen LC, Beard JL, Jones BC. Systems genetics analysis of iron regulation in the brain. Biochimie 2009;91:1255-1259.
Beard JL, Hendricks MK, Perez EM, Murray-Kolb LE, Berg A, Vernon-Feagans L, et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr 2005;135:267-272.
Haas JD, Brownlie Iv T. Iron-Deficiency Anemia: Reexamining the Nature and Magnitude of the Public Health Problem. Summary: implications for research and programs. J Nutr 2001;131:697S-700S; discussion 700S-701S.
Corwin EJ, Murray-Kolb LE, Beard JL. Low hemoglobin level is a risk factor for postpartum depression. J Nutr 2003;133:4139-4142.
Shariatpanaahi MV, Shariatpanaahi ZV, Moshtaaghi M, Shahbaazi SH, Abadi A. The relationship between depression and serum ferritin level. Eur J Clin Nutr 2006;61:532-535.
Beard JL, Connor JR. Iron status and neural functioning. Annu Rev Nutr 2003;23:41-58.
Crayton JW, Walsh WJ. Elevated serum copper levels in women with a history of post-partum depression. J Trace Elem Med Biol 2007;21:17-21.
Johnson WT. Copper and signal transduction: Platelets as a model to determine the role of copper in stimulus- response coupling. BioFactors 1999;10:53-59.
Morgan RF, O’Dell BL. Effect of copper deficiency on the concentration of catecholamines and related enzyme activities in the rat brain. J Neurochem 1977;28:207-213.
Liu J, Yang H, Shi H, Shen C, Zhou W, Dai Q, et al. Blood Copper, Zinc, Calcium, and Magnesium Levels During Different Duration of Pregnancy in Chinese. Biol Trace Elem Res 2009 [Epub ahead of print].
Kuhlman G, Rompala R. The influence of dietary sources of zinc, copper and manganese on canine reproductive performance and hair mineral content. J Nutr 1998;128:2603-2605.
Prohaska JR. Copper deficiency in the developing rat brain: a possible model for Menkes' steely-hair disease. J Neurochem 1974;23: 91-98.
Bogden JD, Thind IS, Louria DB, Caterini H. Maternal and cord blood metal concentrations and low birth weight--a case-control study. Am J Clin Nutr 1978;31:1181-1187.
González F. Trace elements in serum of psychiatric outpatients. poster presentation,Departments of Biochemistry,Psychiatry and Endocrinology: University Hospital "Marques de Valdecilla" Santander Spain;1998.
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Issue | Vol 5 No 2 (2010) | |
Section | Articles | |
Keywords | ||
Copper Iron Magnesium Postpartum depression Trace element Zinc |
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